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Chemo and Tarceva Did Not Cure His Lung Cancer: Another meaningless decline of tumour markers

Jack (not real name) was 43 years old when he was diagnosed with lung cancer. His problem started in October 2013, when there was a swelling in the right collar bone. Apart from this, there was no other symptoms — no cough, etc. Jack said in 2013, he had fevers on three occasions that make him feel tired.

A blood test on 24 October 2013 showed his CEA was at 133.3 and CA 19.9 at 9,524.0

A tru-cut biopsy of the right lung mass was performed and confirmed a moderately differentiated adenocarcinoma.

Jack underwent 6 cycles of chemotherapy. The drug used was Cisplatin. Each cycles cost about RM10,000. The treatment lasted until February 2014.

Let’s follow the progress of Jack’s treatment.

Table 1: Blood test results during chemotherapy.

Date

24 Oct 13

25 Nov 13

16 Dec 13

6 Jan 14

27 Jan 14

17 Feb 14

Total bilirubin

18.1 H

13.7

15.5

13.5

14.8

17.8

Alkaline phosphatase

210 H

217

147

132 (normal)

148

125

ALT

49

62

59

34

26

23

AST

28

30

30

21

19

17

GGT

114 H

n/a

n/a

n/a

n/a

n/a

Platelet

495 H

477

250

258

233

CEA

133.3 H

n/a

n/a

n/a

n/a

n/a

CA 19.9

9,524 H

2,394

325

268

246

195

Before chemo

After chemotherapy

At this stage, chemotherapy was very effective and helpful. Alkaline phosphatase declined. Platelet count was down and CA 19.9 decreased from 9,524 to 195. Bravo – great results.

After the completion of chemotherapy in February 2014, Jack was put on the oral drug Tarceva. He was on Tarceva until June 2015.

His tumour markers – both the CEA and CA 19.9, continued to decrease (Table 2).

Table 2: After intravenous chemo, patient was on oral drug, Tarceva.

Date

25 Mar 14

15 Apr 14

14 May 14

16 Jun 14

21 July 14

18 Aug 14

Total bilirubin

31.6

37.7

27.5

25.5

24.6

27.8

Alakaline phosphatase

142

136

125

84

78

66

ALT

26

43

36

17

16

14

AST

27

56

24

20

19

16

GGT

n/a

n/a

40

26

23

23

Platelet

370

253

281

313

266

281

CEA

n/a

28

2.3

1.9

1.6

1.4

CA 19.9

n/a

14

5.0

6.5

<2.0

3.8

Six months on Tarceva (from February 2014 to August 2014) the CEA and CA 19.9 decreased significantly.Again, great results!

From April 2014 to December 2014 Jack also received 6 to 8 monthly injections of Denosumab. This is a monoclonal antibody used to treat bone cancer. It is also known by its brand name, Xgeva and Prolia.

Table 3: CEA and CA 19.9 started to increase even though Jack was on Tarceva.

Date

22 Sep 14

20 Oct 14

24 Nov 14

29 Dec 14

Total bilirubin

21.8

21.6

21.9

27.1

Alakaline phosphatase

66

76

69

77

ALT

16

15

16

16

AST

18

22

19

20

GGT

23

23

26

24

Platelet

277

329

294

299

CEA

2.2

3.9

7.4

12.6

CA 19.9

7.2

6.6

11.4

27.9

From September 2014 both the CEA and CA 19.9 started to increase in spite of Jack being on Tarceva. In September 2014 the CEA was 2.2 and it increased to 12.6 by December 2014. Similarly, CA 19.9 increased from 7.2 to 27.9 during the same period.

Because of the rising CEA and CA 19.9, Jack was again given 4 cycles of chemo. This time the drugs used were Carboplatin + Gemzar. The total treatment cost RM40,000.

Table 4: The second round of chemo with Carboplatin + Gemzar produced limited benefits.

Date

26 Jan 15

27 Feb 15

6 Mar 15

13 Mar 15

27 Mar 15

Total bilirubin

24.6

17.6

19.9

15.6

24.7

Alakaline phosphatase

74

87

54

67

61

ALT

16

19

25

20

15

AST

21

17

16

16

14

GGT

27

27

27

27

23

Platelet

315

295

453

192

259

CEA

22.3

21.6

22.0

28.6

29.9

CA 19.9

47.2

44.6

31.9

52.5

70.2

From January to April 2015, Carboplatin + Gemzar regime managed to stabalized the CEA level ranging from 22 to 30. CA19.9 stabalized from 31 to 70 during the same period.

Table 5: CEA and CA19.9 on the march — treatment failed!

Date

3 Apr 15

17 Apr 15

24 Apr 15

19 Jun 15

Total bilirubin

20.4

25.8

24.8

33.7

Alakaline phosphatase

49

73

65

73

ALT

24

14

23

12

AST

16

14

18

14

GGT

24

22

24

24

Platelet

509

276

268

321

CEA

29.6

32.7

31.6

93.2

CA 19.9

45.1

52.5

37.7

511.5

Error in platelet reading?

In April CEA was around 29 to 31 while CA 19.9 was around 37 to 45.But barely 2 months after the completion of chemotherapy, the CEA shot up to 93.2 and CA19.9 went up to 511.

Jack said he was disappointed with the results, in spite of the initial good response to chemotherapy. He decided to “shop” for alternative medicine while waiting for his doctor to take the next step.

Comments

This is indeed a sad case but not a unique one. Over the years we have seen cases after cases like this. After the chemo, the tumour markers dropped or the tumour shrunk or disappeared. But such responses did not last long. After a few months, the cancer recurred and this time it became more aggressive.

We sat down with Jack and tried to understand what was going on. No doubt about it, he was very much encouraged with the initial results. Within 8 months of treatment his CA 19.9 which was at 9,524 dropped to less than 2.0. That was a great achievement indeed. Who would not be excited about such feat? But what many patients don’t know or what those who should know do not want to know is that such dramatic drop of CA 19.9 (or even total shrinkage of tumour) is not permanent. It NEVER translates into a cure. It is meaningful in the short term but meaningless in the long term.

Many of us may want to ask: Where is the problem? What causes this problem? What can we do about it?

Jack told us that his oncologist is a very nice man and he was trying his best to cure him. Understandable. We cannot blame the doctor. Legally and medically, apart from chemo or oral drugs, he has nothing else to offer you. He can’t ask you to take supplements or herbs, etc.

Unfortunately, some oncologists will rip apart those who dare to suggest that patients take herbs, vitamins or control their diet. Nonsense they say — all these non-medical ways are not scientifically proven.

But hang on, is the present day treatment like above based on “real science”? Granted, these chemo-drugs have undergone clinical trials and have been approved by Government Authorities. But, what does all this mean? The approved drugs can cure your cancer? Far from it! Ask, why do we see failures after failures being repeated over and over again? It appears that failures seems to be the norm rather than an exception.

I have one suggestion for those who want to do something! Think about it seriously.

Granted, chemo-drugs sometimes can make the tumour markers drop to normal level or the tumour shrunk completely after the treatment. But what do you do after this achievement? Send the patient home and ask him to live the same style of life that he/she had before — the earlier life that promoted his/her cancer?

What if we have a program that teaches patients how to live a healthy life after being effectively treated?

What if we teach them to change their life style and diet?

What if we ask them to take supplements, vitamins or herbs to make them healthy?

What if we ask them to take time to exercise?

These are things that patients can do for themselves when they go home after their “apparently successful” medical treatment. Above all, these are “harmless” efforts that can result in a better and healthier cancer-free life.

In short, why can’t the medical establishment work together with the alternative healers to try and help patients prevent or minimize their cancer recurrence?

At CA Care we teach patients all the above. We take over after patients decide not to go for any more medical treatments. And often for those who are really committed, we succeeded in helping patients to heal themselves.